Contract Pharmacy Details

OREGON CVS PHARMACY, L.L.C.
RWIIR97214B Cascade AIDS Project

Covered Entity Details

Entity Name

Cascade AIDS Project

Subdivision Name

Type

Ryan White Part B ADAP Rebate Option

340B ID

RWIIR97214B

Entity Address

100 East 33rd Street
Suite 201B
Vancouver, WA 98660

Grant Number

X07HA00083

Participating Start Date

4/1/2017

Last Recertification Date

1/29/2020

Entity Termination Date

4/1/2021

Pharmacy Details

Pharmacy Name

OREGON CVS PHARMACY, L.L.C.

Pharmacy Address

CVS PHARMACY # 16125
10775 SW BEAVERTON HILLSDALE HWY
BEAVERTON, OR 97005

Pharmacy Comments

Contract Details

Approval Date

7/17/2018

Contract Begin Date

10/1/2018

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/1/2021
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Tyler A. TerMeer, Executive Director
(503) 278-3810

Contract Pharmacy Representative

CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782

Signed By Date

7/17/2018

340B Drug Pricing Program Database